Overview: Reporting to the Director of Medicaid, the Medicaid Care Manager Team Lead ensures compliance with Medicaid requirements and oversees the daily operations of the Care Management team. This role focuses on delivering quality, member-centered care, reducing emergency room visits, improving health outcomes, and promoting cost-effective services.

Key Responsibilities:

• Provide clinical guidance to Care Managers and support staff.
• Oversee care management workflows, including case referrals, follow-ups, and documentation.
• Ensure care management follows clinical guidelines and organizational standards.
• Perform quality reviews and coach staff to enhance performance.
• Track productivity using data and implement improvement strategies.
• Lead interdisciplinary care team meetings and ensure follow-up on member care.
• Collaborate with Behavioral Health to improve care for co-managed members.
• Handle daily operational issues, escalating as needed to the Director.
• Conduct audits and submit regular reports on department performance.
• Support training and development efforts within the team.
• Ensure staff comply with all mandatory training and policies.

Qualifications:

• Bachelor's degree required, Master's preferred.
• 5+ years of care management experience, with 2+ years in a leadership role.
• Proficiency in Microsoft Office and healthcare systems.
• Ability to interpret medical records and claims data.
• Must hold a current New York State RN license.
• Strong communication, problem-solving, and organizational skills.

Preferred Competencies:

• Integrity, trust, and customer focus.
• Strong leadership, time management, and conflict resolution abilities.
• Ability to work under pressure and adapt to changing priorities.

Medix is acting as an Employment Agency in relation to this vacancy.